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NDM-1 K. pneumoniae identified in 9 patients in Toronto hospital
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Two distinct clones of New Delhi Metallo-β-Lactamase-1-Producing Klebsiella pneumoniae were identified at a tertiary care center in Toronto, researchers reported in Infection Control and Hospital Epidemiology.
Nine patients with NDM-1 K. pneumoniae were identified from January 2011 to March 2012. Pulsed-field gel electrophoresis (PFGE) showed that there were two different clones. For one clone, the index patient had recently received health care in India. The index patient for the second clone had no previous travel to India. Both clones were resistant to beta-lactams, fluoroquinolones, aminoglycosides and trimethoprim-sulfamethoxazole.
“The major take-home message is that the epidemiology of antibiotic-resistant organisms continues to evolve,” Andrew Simor, MD, of Sunnybrook Health Sciences Center in Toronto, told Infectious Disease News. “With regards to carbapenem-resistance associated with NDM-1, this should no longer be considered merely related to medical tourism, as initially described. “We need to acknowledge that gram-negative bacteria carrying this resistance determinant may be acquired and transmitted in health care settings in North America and globally.”
Andrew Simor
The researchers identified 126 patients that were contacts of the patients with NDM-1. Of the seven additional patients who acquired NDM-1 K. pneumoniae, four were roommates, two were ward mates and one had environmental contact. A univariate analysis showed that risk factors for NDM-1 K. pneumoniae acquisition included a history of antibiotic use, particularly fluoroquinolones, TMP-SMX and carbapenems, and a longer duration of exposure to a patient colonized or infected with NDM-1 K. pneumoniae.
Infection control measures included extending admission screening for carbapenem-resistant Enterrobbacteriaceae to patients who received health care in endemic regions, screening contacts of patients identified with NDM-1 K. pneumoniae and reinforcing routing practices such as hand hygiene and cleaning and disinfection standards.
“Our experience indicates that effective control measures to interrupt nosocomial spread of these organisms should include appropriate screening and surveillance for NDM-1 producing Enterobacteriaceae, appropriate use of contact precautions and recognition of the importance of the inanimate hospital environment in transmission of these organisms,” Simor said.
Simor said that additional studies should be conducted to better understand the risks for acquisition and transmission of these resistant organisms, as well as for improved methods of laboratory detection and screening.
Disclosure: Simor reports no relevant financial disclosures.
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Lowe C. Infect Control Hosp Epidemiol. 2013;34:49-55.
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